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Difference between revisions of "Mucinous tumours of the appendix"
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Mucinous tumours of the appendix (view source)
Revision as of 22:10, 8 June 2015
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==General== | ==General== | ||
*There are many classifications and they are controversial.<ref name=pmid21970481>{{Cite journal | last1 = Panarelli | first1 = NC. | last2 = Yantiss | first2 = RK. | title = Mucinous neoplasms of the appendix and peritoneum. | journal = Arch Pathol Lab Med | volume = 135 | issue = 10 | pages = 1261-8 | month = Oct | year = 2011 | doi = 10.5858/arpa.2011-0034-RA | PMID = 21970481 }}</ref> | *There are many classifications and they are controversial.<ref name=pmid21970481>{{Cite journal | last1 = Panarelli | first1 = NC. | last2 = Yantiss | first2 = RK. | title = Mucinous neoplasms of the appendix and peritoneum. | journal = Arch Pathol Lab Med | volume = 135 | issue = 10 | pages = 1261-8 | month = Oct | year = 2011 | doi = 10.5858/arpa.2011-0034-RA | PMID = 21970481 }}</ref> | ||
**The controversy centres on whether to call all mucinous tumours outside of the appendix ''adenocarcinoma'' - regardless of whether they have atypia & show invasion. | **The controversy centres on whether to call all mucinous tumours outside of the appendix ''adenocarcinoma'' - regardless of whether they have [[nuclear atypia|atypia]] & show invasion. | ||
*''Panarelli and Yantiss'' created a nice summary table - that | *Many potential pathways for extra-appendiceal spread and peritoneal mucin deposition (pseudomyxoma peritonei) | ||
**A mucinous neoplasm ruptures the appendix due to expansion by excessive mucin | |||
***Could occur with either a benign or malignant neoplasm. | |||
**Malignant mucinous glands infiltrate through the appendiceal wall or enter the lymphatics and spread throughout the peritoneum. | |||
***Would require a malignant neoplasm. | |||
*''Panarelli and Yantiss'' created a nice summary table - that compares the classifications - see: [http://www.archivesofpathology.org/action/showFullPopup?id=i1543-2165-135-10-1261-t01&doi=10.5858%2Farpa.2011-0034-RA comparison of classifications (archivesofpathology.org)].<ref name=pmid21970481/> | |||
*In women - an ovarian primary must be excluded. | *In women - an ovarian primary must be excluded. | ||
**Concurrent ''bilateral'' ovarian tumours suggests the tumour originated from the appendix and spread to the ovaries. | **Concurrent ''bilateral'' ovarian tumours suggests the tumour originated from the appendix and spread to the ovaries. | ||
*The classification by Misdraji ''et al.''<ref name=pmid12883241>{{cite journal |author=Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH |title=Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases |journal=Am. J. Surg. Pathol. |volume=27 |issue=8 |pages=1089–103 |year=2003 |month=August |pmid=12883241 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=27&issue=8&spage=1089}}</ref> is a good starting point if one is unfamilar with the topic, as it is the least complicated. | *The 2003 classification by Misdraji ''et al.''<ref name=pmid12883241>{{cite journal |author=Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH |title=Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases |journal=Am. J. Surg. Pathol. |volume=27 |issue=8 |pages=1089–103 |year=2003 |month=August |pmid=12883241 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=27&issue=8&spage=1089}}</ref> is a good starting point if one is unfamilar with the topic, as it is the least complicated. | ||
===Misdraji classification=== | ===Misdraji classification of 2003=== | ||
*Benign - ''low grade mucinous tumour''. | *Benign - ''low grade mucinous tumour''. | ||
*Borderline - ''mucinous tumour of uncertain malignant potential'' or ''borderline mucinous tumour''. | *Borderline - ''mucinous tumour of uncertain malignant potential'' or ''borderline mucinous tumour''. | ||
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**Vaguely resemble ''serrations'', i.e. the ''saw-tooth'' pattern in hyperplastic polyps of the colon. | **Vaguely resemble ''serrations'', i.e. the ''saw-tooth'' pattern in hyperplastic polyps of the colon. | ||
*Mucin contained (inside appendix only). | *Mucin contained (inside appendix only). | ||
** mucin extravasation into the appendiceal wall does not upgrade the tumour. | |||
*No marked nuclear atypia. | *No marked nuclear atypia. | ||
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Image: Mucinous cystadenoma of the appendix - alt -- high mag.jpg | Mucinous cystadenoma - high mag. (WC) | Image: Mucinous cystadenoma of the appendix - alt -- high mag.jpg | Mucinous cystadenoma - high mag. (WC) | ||
Image: Mucinous cystadenoma of the appendix -- very high mag.jpg | Mucinous cystadenoma - very high mag. (WC) | Image: Mucinous cystadenoma of the appendix -- very high mag.jpg | Mucinous cystadenoma - very high mag. (WC) | ||
Image: Appendix LowGradeMucinousNeoplasm MucinousNeoplasm LowGrade LP PA.JPG|Low Grade Appendiceal Mucinous Neoplasm - low power (SKB) | |||
Image: Appendix LowGradeMucinousNeoplasm LP-2 PA.JPG|Low Grade Appendiceal Mucinous Neoplasm - mucin extravasation into the appendiceal wall- low power (SKB) | |||
Image: Appendix LowGradeMucinousNeoplasm LP - Copy PA.JPG|Low Grade Appendiceal Mucinous Neoplasm - mucin extravasation into the appendiceal wall - low power (SKB) | |||
Image: Appendix LowGradeMucinousNeoplasm MucinousNeoplasm LowGrade HP (2) PA.JPG|Low Grade Appendiceal Mucinous Neoplasm - medium power (SKB) | |||
Image: Appendix LowGradeMucinousNeoplasm MucinousNeoplasm LowGrade HP PA.JPG|Low Grade Appendiceal Mucinous Neoplasm - high power (SKB) | |||
Image: Appendix LowGradeMucinousNeoplasm LP 14BR***.jpg|Low Grade Appendiceal Mucinous Neoplasm - low power (SKB) | |||
Image: Appendix LowGradeMucinousNeoplasm MP 14BR***.jpg|Low Grade Appendiceal Mucinous Neoplasm - medium power (SKB) | |||
</gallery> | </gallery> | ||
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VERMIFORM APPENDIX, APPENDECTOMY: | VERMIFORM APPENDIX, APPENDECTOMY: | ||
- LOW-GRADE APPENDICEAL MUCINOUS NEOPLASM. | - LOW-GRADE APPENDICEAL MUCINOUS NEOPLASM. | ||
-- NEGATIVE FOR EXTRA-APPENDICEAL MUCIN. | |||
-- MARGINS NEGATIVE FOR MUCINOUS NEOPLASM. | |||
- ACUTE APPENDICITIS. | - ACUTE APPENDICITIS. | ||
- ACUTE PERIAPPENDICITIS. | - ACUTE PERIAPPENDICITIS. | ||